The early months of the COVID-19 pandemic reduced patient access to specialised stroke units and evidence-based therapies, according to data from the Australian Stroke Clinical Registry (AuSCR).
The retrospective study of 27,512 patients admitted to hospital with stroke or TIA between January 2019 and June 2020 found the proportion of patients treated in a stroke unit decreased from 76% during the pre-pandemic period to 69% during the pandemic.
The study, published in the Journal of Stroke, said distributions of diagnosis, previous history of stroke, arrival by ambulance, and transfer from another hospital were also different between the pre-pandemic and pandemic periods.
“Compared with patients who were treated outside of stroke units, patients treated in stroke units were more often male, more often had an ischaemic stroke, less often had an in-hospital stroke, more often arrived by ambulance, more often transferred from another hospital, less often able to walk on admission (proxy for greater stroke severity), and had longer lengths of stay in both the pre-pandemic and pandemic periods.”
Patients treated in stroke units more often received evidence-based care in both the pre-pandemic and pandemic periods compared with those treated in other ward settings
“Among those treated outside of stroke units, there was a reduction from the pre-pandemic period to the pandemic period in the proportion of patients receiving mobilisation, swallow screen or assessment, and secondary prevention medications at discharge from the hospital.”
“Using the same cohort, we had previously reported that access to intravenous thrombolysis and endovascular clot retrieval were similar; however, door-to-needle times were longer during the peak national pandemic period (March to April 2020),” the researchers said.
They said their findings reinforce the importance of ensuring the availability of doctors, nurses, and allied health staff with expertise and experience in managing patients with stroke are treating people with the condition.
“Care in stroke units by staff with expertise must be preferentially offered during a pandemic to ensure standards of care are upheld,” they suggested.